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Presume J, Paiva MS, Guerreiro S, Ribeiras R. Parameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy. J Int Med Res 2023; 51:3000605231218645. [PMID: 38150557 PMCID: PMC10754024 DOI: 10.1177/03000605231218645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023] Open
Abstract
The mitral valve apparatus is a complex structure consisting of several coordinating components: the annulus, two leaflets, the chordae tendineae, and the papillary muscles. Due to the intricate interplay between the mitral valve and the left ventricle, a disease of the latter may influence the normal function of the former. As a consequence, valve insufficiency may arise despite the absence of organic valve disease. This is designated as functional or secondary mitral regurgitation, and it arises from a series of distortions to the valve components. This narrative review describes the normal anatomy and the pathophysiology behind the mitral valve changes in ischemic and non-ischemic dilated cardiomyopathies. It also explains the value of a complete multiparametric assessment of this structure. Not only must an assessment include quantitative measures of regurgitation, but also various anatomical parameters from the mitral apparatus and left ventricle, since they carry prognostic value and are predictors of mitral valve repair success and durability.
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Affiliation(s)
- João Presume
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
- Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Mariana S Paiva
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Sara Guerreiro
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
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Marchetti D, Di Lenarda F, Novembre ML, Paolisso P, Schillaci M, Melotti E, Doldi M, Terzi R, Gallazzi M, Conte E, Volpato V, Bartorelli A, Andreini D. Contemporary Echocardiographic Evaluation of Mitral Regurgitation and Guidance for Percutaneous Mitral Valve Repair. J Clin Med 2023; 12:7121. [PMID: 38002733 PMCID: PMC10672624 DOI: 10.3390/jcm12227121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/16/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Mitral valve regurgitation (MR) is a multifaceted valvular heart disease. Echocardiography plays a central role in etiology assessment, severity quantification, treatment candidacy, outcome evaluation, and patient follow-up. In this review, we describe the comprehensive echocardiographic assessment of MR, including transthoracic (TTE) and transesophageal (TEE) approaches, 2D and 3D modalities, strain imaging, stress echocardiography, and artificial intelligence (AI) applications. Transcatheter edge-to-edge mitral valve repair (TEER) has been established as a key therapy for patients with severe, symptomatic MR and high surgical risk. TEER is performed under TEE guidance. We outline a practical overview of echocardiographic guidance on TEER.
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Affiliation(s)
- Davide Marchetti
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Francesca Di Lenarda
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Maria Laura Novembre
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Pasquale Paolisso
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Matteo Schillaci
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Eleonora Melotti
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Marco Doldi
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Riccardo Terzi
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Michele Gallazzi
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Edoardo Conte
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Valentina Volpato
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Antonio Bartorelli
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
| | - Daniele Andreini
- Division of University Cardiology, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20100 Milan, Italy; (D.M.); (E.M.); (R.T.); (A.B.)
- Department of Clinical and Biomedical Sciences, University of Milan, 20100 Milan, Italy
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Altes A, Vermes E, Levy F, Vancraeynest D, Pasquet A, Vincentelli A, Gerber BL, Tribouilloy C, Maréchaux S. Quantification of primary mitral regurgitation by echocardiography: A practical appraisal. Front Cardiovasc Med 2023; 10:1107724. [PMID: 36970355 PMCID: PMC10036770 DOI: 10.3389/fcvm.2023.1107724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.
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Affiliation(s)
- Alexandre Altes
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Franck Levy
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - André Vincentelli
- Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Correspondence: Sylvestre Maréchaux
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Pellikka PA. Looking to the Future for the Journal of the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:1-2. [PMID: 36604018 DOI: 10.1016/j.echo.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 01/04/2023]
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